Kelly G. Wilson

Measuring experiential avoidance: A preliminary test of a working model

The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.

Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial

Approximately 14% of the working-age Swedish population are either on long-term sick leave or early retirement due to disability. Substantial increase of sick listing, reports of work disabilities and early retirement due to stress and musculoskeletal chronic pain suggest a need for methods of preventing loss of function resulting from these conditions. The present preliminary investigation examined the effects of a brief Acceptance and Commitment Therapy (ACT) intervention for the treatment of public health sector workers who showed chronic stress/pain and were at risk for high sick leave utilization. ACT was compared in an additive treatment design with medical treatment as usual (MTAU). A group of 19 participants were randomly distributed into 2 groups. Both conditions received MTAU. The ACT condition received four 1-hour weekly sessions of ACT in addition to MTAU. At post and 6-month follow-up, ACT participants showed fewer sick days and used fewer medical treatment resources than those in the MTAU condition. No significant differences were found in levels of pain, stress, or quality of life. Improvements in sick leave and medical utilization could not be accounted for by remission of stress and pain in the ACT group as no between-group differences were found for stress or pain symptoms.

The Valued Living Questionnaire: Defining and Measuring Valued Action within a Behavioral Framework.

A number of cognitive-behavior therapies now strongly emphasize particular behavioral processes as mediators of clinical change specific to that therapy. This shift in emphasis calls for the development of measures sensitive to changes in the therapies’ processes. Among these is acceptance and commitment therapy (ACT), which posits valued living as one of its primary core processes. This article offers a definition of values from a behavioral perspective and describes the Valued Living Questionnaire (VLQ) as a first attempt at assessment of valued living. The VLQ is a relatively brief and easily administered instrument derived directly from the primary text on ACT. Initial psychometric support for the VLQ suggests that valued living can be measured, even with the most simple of instruments, in such a way as to consider it a possible mechanism of change in ACT and related approaches.

A Preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts

The present study compared methadone maintenance alone to methadone maintenance in combination with 16 weeks of either Intensive Twelve-Step Facilitation (ITSF) or Acceptance and Commitment Therapy (ACT) in a preliminary efficacy trial with polysubstance-abusing opiate addicts who were continuing to use drugs while on methadone maintenance. Results showed that the addition of ACT was associated with lower objectively assessed opiate and total drug use during follow-up than methadone maintenance alone, and lower subjective measures of total drug use at follow-up. An intent-to-treat analysis which assumed that missing drug data indicated drug use also provided support for the reliability of objectively assessed total drug use decreases in the ACT condition. ITSF reduced objective measures of total drug use during follow-up but not in the intent-to-treat analyses. Most measures of adjustment and psychological distress improved in all conditions, but there was no evidence of differential improvement across conditions in these areas. Both ACT and ITSF merit further exploration as a means of reducing severe drug abuse.

Acceptance and commitment therapy: Altering the verbal support for experiential avoidance.

Acceptance and Commitment Therapy (ACT) is a behavior-analytically-based psychotherapy approach that attempts to undermine emotional avoidance and increase the capacity for behavior change. An overview of this approach is given, followed by several specific examples of the techniques used within ACT. In each instance the behavioral rationale of these techniques is described. A contemporary view of verbal relations provides the basis for new approaches to adult outpatient psychotherapy.

What Is Acceptance and Commitment Therapy

ACT is an example of a third wave behavior therapy that saves direct change strategies for overt behaviors and utilizes contextual and experiential methods such as mindfulness and acceptance to address cognitive process that hinder and limit overt behavioral change. The treatment is informed by RFT and is based on the philosophical position of functional contextualism. ACT seeks to undermine the literal grip of language (relational framing) that fosters experiential avoidance, cognitive fusion, and behavioral inflexibility, through the application of six core psychological techniques: acceptance, defusion, contact with the present moment, self-as as-context, values, and commitment to behavior change. Homework can play an integral role in the application of these techniques, by supporting the in-session therapy. Homework can be especially useful because it allows the client to utilize these principles in situations that cannot be created in the therapy sessions, such as public situation for someone who struggles with anxiety. As with most therapies, ACT has its own homework assignments, but therapists often create new techniques to serve the clients needs.

An Experimental Test of a Cognitive Defusion Exercise: Coping with Negative and Positive Self-Statements.

This study investigated the impact of defusion on a nonclinical sample (n = 60) in the context of negative (e.g., “I am a bad person”) and positive (e.g., “I am whole”) self-statements. Participants were assigned to one of three experimental conditions (Pro-Defusion, Anti-Defusion, and Neutral) that manipulated instructions about the impact of a defusion strategy. Defusion was also manipulated through the visual presentation of the self-statements, with each presented in three formats (Normal, Defused, Abnormal). Participants rated each self-statement for comfort, believability, and willingness. Although the instructions did not affect ratings, negative statements presented in the defused format decreased discomfort and increased willingness and believability relative to the nondefused statements. The findings suggest using defusion strategies in coping with negative psychological content.

The role of cognition in complex human behavior: A contextualistic perspective

Cognitive and behavioral psychology have long debated the merits of cognitive causality in the explanation of human behavior. We argue, however, that cognitive causality must be understood in the context of the pre-analytic philosophical assumptions of the scientist, not merely as an empirical matter. Many of the issues that seemingly separate cognitive from behavioral positions cannot be answered by research. We briefly present Relational Frame Theory, which is a behavioral approach to language and cognition. RFT is not subject to the same criticisms made by Bandura of behavior analytic thinking. Finally, we describe some aspects of Acceptance and Commitment Therapy as an example of the applied implications of this contextual analysis of cognition.

14 Stimulus classes and stimulus relations: Arbitrarily applicable relational responding as an operant

Publisher Summary The chapter discusses stimulus classes and stimulus relations. Humans show remarkable forms of stimulus control based upon seemingly arbitrary relations among stimuli. Normal adults who are told that a bottle contains poison will probably avoid that bottle, perhaps for life. The research interest in equivalence and other derived stimulus relations documents the fascination such performances have for behavioral psychologists. As with any behavior, a satisfactory behavior analytic account of these performances requires a specification of the nature of the activity and the antecedent, consequential, motivative, and other variables involved in its manipulation and prediction. This chapter includes one such analysis and explores some of its implications for the understanding of human stimulus control. It discusses the basic premises of relational frame theory (RFT) and the ways in which it informs an understanding of complex stimulus control among verbally competent humans. Most of the work on derived stimulus relations has been done on stimulus equivalence. There are several preparations used to establish stimulus equivalence in an experimental setting, but by far the most popular is matching-to-sample (MTS). In arbitrary MTS, a sample stimulus appears with an array of comparison stimuli, one of which is then selected. The stimulus arrangements and responses required vary.

A Stage I Pilot Study of Acceptance and Commitment Therapy for Methadone Detoxification

BACKGROUND While agonist replacement therapies are effective for managing opioid dependence, community treatment programs are increasingly choosing detoxification. Unfortunately, success rates for opioid detoxification are very low, in part, due to physical and psychological symptoms associated with opioid withdrawal. Few behavior therapies specifically address the distressing experiences specific to opioid withdrawal. A novel behavioral treatment, acceptance and commitment therapy (ACT), works from the premise that the avoidance of unpleasant private experiences (thoughts, feelings, bodily sensations) is ubiquitous yet may be pathogenic, resulting in treatment drop-out and further drug use. METHODS This Stage I pilot study developed and tested an ACT-based opioid detoxification behavioral therapy. Opioid dependent patients (N=56) who were attending a licensed methadone clinic were randomized to receive either 24 individual therapy sessions of ACT or drug counseling (DC) in the context of a 6-month methadone dose reduction program. RESULTS While no difference was found on opioid use during treatment, 37% of participants in the ACT condition were successfully detoxified at the end of treatment compared to 19% of those who received DC. Fear of detoxification was also reduced across time in the ACT condition relative to DC. CONCLUSION This first study of ACT to assist opioid detoxification indicates promise. Research is needed to refine specific treatment strategies for this population to further strengthen effects.